Dataset Information

Jurisdiction size and local public health spending.

ABSTRACT:

Objective

To examine if a minimum efficient scale (MES) holds with respect to the population serviced by a local health department (LHD) given the congestability, externality, and scale/scope economy effects potentially associated with public health services.

Data sources/study setting

A nationally representative sample of LHDs in 2005.

Study design

Multiple regression analysis is used to isolate the relation between population and spending while controlling for other factors known to influence local public health costs.

Data collection

Data were obtained from the 2005 National Profile of Local Public Health Agencies, a project supported through a cooperative agreement between the National Association of County and City Health Officials and the Centers for Disease Control and Prevention.

Principal findings

The MES of a local public health department is approximately 100,000 people. After that size, additional population has little impact on public health spending per capita.

Conclusions

Seventy-seven percent of LHDs in the sample fall below the 100,000 MES. Higher levels of government may want to provide financial inducements so that smaller LHDs consolidate or enter into agreements with larger public health organizations to provide services.

SUBMITTER: Santerre RE

PROVIDER: S-EPMC2796319 | biostudies-literature | 2009 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Jurisdiction size and local public health spending.

Santerre Rexford E RE

Health services research 20090727 6

<h4>Objective</h4>To examine if a minimum efficient scale (MES) holds with respect to the population serviced by a local health department (LHD) given the congestability, externality, and scale/scope economy effects potentially associated with public health services.<h4>Data sources/study setting</h4>A nationally representative sample of LHDs in 2005.<h4>Study design</h4>Multiple regression analysis is used to isolate the relation between population and spending while controlling for other facto ...[more]

PMID: 19656226

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Project description:ObjectivesChanges in public sector service spending may influence food consumption. We make use of changing local authority (LA) expenditure in England to assess impacts on food purchasing. We examine total LA service spending and explore two potential pathways: highways and transport spending which may affect access to food; and housing service expenditure which may affect household resources available to purchase foods.DesignLongitudinal panel survey at the LA level (2008-2015) using fixed effects linear regression.Setting324 LAs in England.Main exposureExpenditure per capita on total LA services, highways and transport services, and housing services.Main outcome measuresLA area estimates of purchasing of fresh fruits and vegetables, high in fat, sugar and salt (HFSS) foods, and takeaways at home, expressed as a percentage of total food and drink expenditure.ResultsTotal LA service spending decreased by 17% on average between 2008 and 2015. A 10% decrease in total LA spending was associated with a 0.071 percentage point decrease in HFSS (95% CI -0.093 to -0.050) and a 0.015 percentage point increase in takeaways (95% CI 0.006 to 0.024). A 10% decrease in highways and transport expenditure was associated with a 0.006 percentage point decrease in fruit and vegetable purchasing (95% CI -0.009 to -0.002) and a 0.006 percentage point increase in takeaway purchasing (95% CI 0.001 to 0.010). These associations were seen in urban areas only when analyses were stratified by rural/urban area status. A 0.006 percentage point decrease in HFSS purchasing was also seen with a 10% decrease in housing expenditure (95% CI -0.010 to -0.002).ConclusionChanges in LA spending may have impacts on food purchasing which are evident at the area level. This suggests that in addition to more prominent impacts such as foodbank use, austerity measures may have mixed impacts on food purchasing behaviours among the wider population. Individual-level research is needed to further elucidate these relationships.

Dataset Information

Jurisdiction size and local public health spending.

Objective

Data sources/study setting

Study design

Data collection

Principal findings

Conclusions

Publications

Jurisdiction size and local public health spending.

Similar Datasets

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